Rosen P P, Senie R, Schottenfeld D, Ashikari R
Ann Surg. 1979 Mar;189(3):377-82. doi: 10.1097/00000658-197903000-00021.
One hundred twenty-nine biopsies from 121 patients with a frozen or paraffin section diagnosis of noninvasive breast carcinoma were studied. Eight women had bilateral noninvasive carcinoma. Seven biopsies reported as intraductal on frozen section contained invasive carcinoma on paraffin section. Of the remaining 122 biopsies proven to have noninvasive carcinoma on paraffin section, 39 (34%) were reported at frozen section and as noninvasive carcinoma, 24 (20%) as atypical and 59 (48%) as benign. Intraductal carcinoma (IDC) was identified more often at frozen section (45%) than was lobular carcinoma in situ (19%). Among 41 patients who had bilateral carcinoma with invasive disease in one breast, 76% of contralateral noninvasive carcinoma was LCIS. After excisional biopsy, carcinoma was found in 56% of 103 mastectomy specimens, including invasive carcinoma in 6% of breasts with IDC and 4% with LCIS. Residual noninvasive carcinoma was usually of the same type found at biopsy (90% IDC and 88% LCIS) and involved quadrants other than the biopsy site in 33% with IDC and in 80% with LCIS. When the frozen or paraffin section diagnosis of a generous excisional biopsy was noninvasive breast carcinoma, there was a substantial risk that foci of the same type of noninvasive carcinoma were also present in other quadrants. However, occult foci of invasive carcinoma were quite infrequent and the risk of axillary metastases was very low. Adequate treatment for noninvasive carcinoma requires elimination of all residual foci of noninvasive disease. At present this can best be accomplished by total mastectomy if the operation is properly performed. To insure removal of the axillary extension of the breast and for staging, in continuity dissection of the lowest axillary lymph nodes is also prudent.
对121例经冰冻切片或石蜡切片诊断为非浸润性乳腺癌患者的129份活检标本进行了研究。8名女性患有双侧非浸润性癌。7份冰冻切片报告为导管内癌的活检标本，石蜡切片显示为浸润性癌。在其余122份经石蜡切片证实为非浸润性癌的活检标本中，39份（34%）在冰冻切片时报告为非浸润性癌，24份（20%）报告为非典型性，59份（48%）报告为良性。导管内癌（IDC）在冰冻切片时的检出率（45%）高于小叶原位癌（19%）。在41例一侧乳房患有浸润性疾病的双侧癌患者中，对侧非浸润性癌的76%为小叶原位癌。切除活检后，在103份乳房切除标本中有56%发现癌，其中在IDC乳房中有6%发现浸润性癌，在小叶原位癌乳房中有4%发现浸润性癌。残留的非浸润性癌通常与活检时发现的类型相同（90%为IDC，88%为小叶原位癌），在IDC中33%累及活检部位以外的象限，在小叶原位癌中80%累及活检部位以外的象限。当大块切除活检的冰冻或石蜡切片诊断为非浸润性乳腺癌时，其他象限也存在同一类型非浸润性癌灶的风险很大。然而，隐匿性浸润癌灶相当少见，腋窝转移风险很低。非浸润性癌的充分治疗需要清除所有残留的非浸润性病灶。目前，如果手术操作得当，全乳切除术是实现这一目标的最佳方法。为确保切除乳房的腋窝延伸部分并进行分期，连续解剖最低位腋窝淋巴结也是明智的。
